Form A
Continuing and Distance Education

It is only necessary to complete this application if you are pursuing an entire program through Continuing and Distance Education. If you would like to register for a single course, please fill out this form instead.

1. Please indicate your desired program:

Briercrest College:

BA Christian Studies

Bible Certificate

Briercrest Seminary:

2. Personal Information

Title:

Mr.

Mrs.

Miss

Ms.

First name:

Last name:

Permanent Mailing Address:

Other names that may appear on your transcripts
(e.g. maiden, nicknames)

City:

Province/State:

Postal/Zip Code:

Country

Home Phone:

-
-

Cell Phone:

-
-

Work Phone:

-
-

Email Address:

Please check here if you would like Briercrest to text you with updates on your application.

Email address is:

Your Address

Family's Address

Other

Social Insurance / Security Number:

Citizenship:

Canadian

United States

Other:

Date of Birth (mm/dd/yy):

/ /

3. Finances

What will you need to depend on to finance your education? Savings Church Sponsoring Agency Other

4. Statistical Data

Have you applied or will you be applying to any other schools this year? If so, which one(s)?

Have you visited our campus?

Yes

No

If yes, when and for which event?

How did you first hear about Briercrest?

What was the main factor that influenced you to apply?

5. Church Information

Name of local church you currently attend:

Complete Address:

Phone Number:

Denomination:

Senior Pastor:

Alumnus of Briercrest?

Yes

No

Associate Pastor:

Alumnus of Briercrest?

Yes

No

Youth Pastor:

Alumnus of Briercrest?

Yes

No

6. Education

High School(s) Attended

Name of Institution

City, Province/State

Date(s) of Attendance

Grade Completed

Post-Secondary School(s) Attended

Name of Institution

City, Province/State

Date(s) of Attendance

Programs or Courses Completed

Graduate School(s) Attended

Name of Institution

City, Province/State

Date(s) of Attendance

Programs or Courses Completed

Payment Information (optional)

You can choose to submit your application fee online by entering in your credit card information below.
The application fee is $50.

Name as on Card

Card Type

Card Number

Expiry Date:

To the best of my knowledge the information provided on this form is accurate and truthful. I understand and accept that submission of this application does not imply my acceptance as a student, and that Briercrest College and Seminary retains the right to refuse my application in its sole discretion without further obligation to me. The personal information provided in this application, including Forms A, B, C and E, may be used by Briercrest employees and representatives for purposes that are appropriate for fulfilling the institutional mission and providing me with a quality education.